Introduction to Pandemic Influenza

Introduction to Pandemic Influenza

Public Health emergencies and international disaster response

Public Health emergencies and international disaster response

ObjectivesObjectives

• To understand the pattern of infectious disease outbreaks

• To understand the historical significance and impacts of pandemic influenza outbreaks

• To learn the WHO protocols and guidelines for combating infectious diseases

• To understand the steps in the process of identifying, responding to, and recovering from pandemic influenza pandemics

• To understand the pattern of infectious disease outbreaks

• To understand the historical significance and impacts of pandemic influenza outbreaks

• To learn the WHO protocols and guidelines for combating infectious diseases

• To understand the steps in the process of identifying, responding to, and recovering from pandemic influenza pandemics

World Health Organization Phases of a Pandemic

World Health Organization Phases of a Pandemic

• WHO has six phases for a pandemic that are under review following the H1N1 pandemic

• Each Phase has specific activities recommended to governments

• Each phase has communication recommendations

• International Health Regulations of 2005• Novel virus and severity of the virus must be

linked in new phase release

• WHO has six phases for a pandemic that are under review following the H1N1 pandemic

• Each Phase has specific activities recommended to governments

• Each phase has communication recommendations

• International Health Regulations of 2005• Novel virus and severity of the virus must be

linked in new phase release

EpidemiologyEpidemiology

• Incubation period about 1 to 4 days

•2-3 days for H1N1, 2-8 days for H5N1

• Infective for about 5 to 7 days

•up to 2 weeks in high-risk individuals

• Infectious up to 24 hours BEFORE symptoms

• May be asymptomatic (30 - 50%)

How do we identify infected

individuals

How do we identify infected

individuals Picture: http://www.molecularlab.it/public/news/_20050916_influenza_aviaria_polli.jpg

SARS

5 to 7 days

1 to 2 weeks

When symptomatic

All ill

Clinical FeaturesClinical Features

Fever (3 - 7 days)

Dry cough

Loss of appetite

Weakness

Blocked nose

Muscle aches

Sore throat

Headache

Lethargy (2 weeks)

Pneumonia

Runny nose

High Risk PopulationsHigh Risk Populations

• Schools– Children have longer viral shedding period– Greater opportunities for spread

• Military facilities– Close living quarters– Field hygiene

• Incarcerated– Prisons– Mental facilities

• Elderly care facilities

• Schools– Children have longer viral shedding period– Greater opportunities for spread

• Military facilities– Close living quarters– Field hygiene

• Incarcerated– Prisons– Mental facilities

• Elderly care facilities

Who is a “close contact”?Who is a “close contact”?

• People who came within 1 meter of shared space with a confirmed or suspect case patient beginning 1 day before onset of symptoms through 14 days after onset of symptoms.

• People who came within 1 meter of shared space with a confirmed or suspect case patient beginning 1 day before onset of symptoms through 14 days after onset of symptoms.

Picture: http://www.molecularlab.it/public/news/_20050916_influenza_aviaria_polli.jpg

Droplet PrecautionsDroplet Precautions

• Prevent infection by large droplets from– Sneezing– Coughing– Talking

• Examples– Neisseria meningitidis– Pertussis– Influenza– Avian influenza (probable)

• Prevent infection by large droplets from– Sneezing– Coughing– Talking

• Examples– Neisseria meningitidis– Pertussis– Influenza– Avian influenza (probable)

Rapid ResponseRapid Response• Strong Surveillance systems will provide the

opportunity to “Contain” a virus or bacteria before it can spread; Two weeks response

• Launching a Containment Operation to seal off a geographically defined area requires a PRE-DEFINED DECISION-MAKING PROCESS

• Logistical support and trained personnel• A Risk Communication Plan and support

from the local authorities• Plan for 6 weeks of support for 10,000

people

• Strong Surveillance systems will provide the opportunity to “Contain” a virus or bacteria before it can spread; Two weeks response

• Launching a Containment Operation to seal off a geographically defined area requires a PRE-DEFINED DECISION-MAKING PROCESS

• Logistical support and trained personnel• A Risk Communication Plan and support

from the local authorities• Plan for 6 weeks of support for 10,000

people

Rapid Containment Cannot Be “Business as Usual”

Rapid Containment Cannot Be “Business as Usual”

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Societal ImpactsSocietal Impacts

• School closures• Air transportation and general movement of

goods• Potential Border Closures (Tourism decline)• Economic slow down • Health system overload from flu patients

– Care for normal sick is reduced– Supplies and staff become over burdened

• School closures• Air transportation and general movement of

goods• Potential Border Closures (Tourism decline)• Economic slow down • Health system overload from flu patients

– Care for normal sick is reduced– Supplies and staff become over burdened

Sustaining Essential ServicesSustaining Essential Services• Planning estimates are that 40% of the work

forces will be affected• Essential services will deteriorate slowly

– Health services (patient care and Public Health)– Water and Sanitation– Food and agriculture production– Power (fuel and power grids)– Communications– Banking and finance– Transportation– Rule of law (police, courts, prisons, and national

security

• Planning estimates are that 40% of the work forces will be affected

• Essential services will deteriorate slowly– Health services (patient care and Public Health)– Water and Sanitation– Food and agriculture production– Power (fuel and power grids)– Communications– Banking and finance– Transportation– Rule of law (police, courts, prisons, and national

security

Non-Pharmaceutical Interventions

Non-Pharmaceutical Interventions

• Infection controls• Voluntary isolation of sick people• Voluntary quarantine of healthy contacts• School closures• Social distancing• Travel restrictions• Mask use• Hand washing

• Infection controls• Voluntary isolation of sick people• Voluntary quarantine of healthy contacts• School closures• Social distancing• Travel restrictions• Mask use• Hand washing

Current Seasonal Influenza Vaccine Production Timeline: 6 - 9 months

Current Seasonal Influenza Vaccine Production Timeline: 6 - 9 months

Enough eggs? Strain selection? Adjuvants? Repeat doses? Expiration?

Potential Strategies to Decrease the Impact of a Pandemic

Potential Strategies to Decrease the Impact of a Pandemic

• Prevent or delay introduction, slow spread

• Decrease illness and death

– Vaccine when available

– Antiviral treatment and isolation for people with illness

– Non-pharmaceutical interventions

• Prevent or delay introduction, slow spread

• Decrease illness and death

– Vaccine when available

– Antiviral treatment and isolation for people with illness

– Non-pharmaceutical interventions

Weeks

Impact

Prepared

Unprepared

SummaryCombating a Pandemic; the

three keys to success

SummaryCombating a Pandemic; the

three keys to success

• Knowledge of the virus is critical– Mutations and movement– Laboratory testing capabilities (Field and Lab

testing)

• Vaccines (6-9 months)– Development– Manufacturing– Distribution

• Non-Pharmaceutical interventions– Population compliance or non-compliance

• Knowledge of the virus is critical– Mutations and movement– Laboratory testing capabilities (Field and Lab

testing)

• Vaccines (6-9 months)– Development– Manufacturing– Distribution

• Non-Pharmaceutical interventions– Population compliance or non-compliance